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Ogut E, Armagan K. Evaluation of the Potential Impact of Medical Ozone Therapy on Covid-19: A Review Study. OZONE: SCIENCE & ENGINEERING 2023; 45:213-231. [DOI: 10.1080/01919512.2022.2065242] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/07/2022] [Indexed: 07/22/2023]
Affiliation(s)
- Eren Ogut
- Department of Anatomy, School of Medicine, Bahçeşehir University, İstanbul, 34715, Turkey
| | - Kutay Armagan
- Medical Faculty Student, School of Medicine, Bahcesehir University, Istanbul, Turkey
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2
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Ogut E, Armagan K. Evaluation of the Potential Impact of Medical Ozone Therapy on Covid-19: A Review Study. OZONE: SCIENCE & ENGINEERING 2023; 45:213-231. [DOI: https:/doi.org/10.1080/01919512.2022.2065242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/07/2022] [Indexed: 07/22/2023]
Affiliation(s)
- Eren Ogut
- Department of Anatomy, School of Medicine, Bahçeşehir University, İstanbul, 34715, Turkey
| | - Kutay Armagan
- Medical Faculty Student, School of Medicine, Bahcesehir University, Istanbul, Turkey
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3
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Epelle E, Macfarlane A, Cusack M, Burns A, Okolie JA, Vichare P, Rolland L, Yaseen M. Ozone Decontamination of Medical and Nonmedical Devices: An Assessment of Design and Implementation Considerations. Ind Eng Chem Res 2023; 62:4191-4209. [PMID: 36943762 PMCID: PMC10020969 DOI: 10.1021/acs.iecr.2c03754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
The control of infectious diseases can be improved via carefully designed decontamination equipment and systems. Research interest in ozone (a powerful antimicrobial agent) has significantly increased over the past decade. The COVID-19 pandemic has also instigated the development of new ozone-based technologies for the decontamination of personal protective equipment, surfaces, materials, and indoor environments. As this interest continues to grow, it is necessary to consider key factors affecting the applicability of lab-based findings to large-scale systems utilizing ozone. In this review, we present recent developments on the critical factors affecting the successful deployments of industrial ozone technologies. Some of these include the medium of application (air or water), material compatibility, efficient circulation and extraction, measurement and control, automation, scalability, and process economics. We also provide a comparative assessment of ozone relative to other decontamination methods/sterilization technologies and further substantiate the necessity for increased developments in gaseous and aqueous ozonation. Modeling methodologies, which can be applied for the design and implementation of ozone contacting systems, are also presented in this review. Key knowledge gaps and open research problems/opportunities are extensively covered including our recommendations for the development of novel solutions with industrial importance.
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Affiliation(s)
- Emmanuel
I. Epelle
- School
of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
- ACS
Clothing, 6 Dovecote
Road Central Point Logistics Park, Centralpark ML1 4GP, United
Kingdom
| | - Andrew Macfarlane
- ACS
Clothing, 6 Dovecote
Road Central Point Logistics Park, Centralpark ML1 4GP, United
Kingdom
| | - Michael Cusack
- ACS
Clothing, 6 Dovecote
Road Central Point Logistics Park, Centralpark ML1 4GP, United
Kingdom
| | - Anthony Burns
- ACS
Clothing, 6 Dovecote
Road Central Point Logistics Park, Centralpark ML1 4GP, United
Kingdom
| | - Jude A. Okolie
- Gallogly
College of Engineering, University of Oklahoma, Norman, Oklahoma 73019, United States
of America
| | - Parag Vichare
- School
of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
| | - Luc Rolland
- School
of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
| | - Mohammed Yaseen
- School
of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
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4
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Shang W, Wang Y, Wang G, Han D. Benefits of ozone on mortality in patients with COVID-19: A systematic review and meta-analysis. Complement Ther Med 2023; 72:102907. [PMID: 36513208 PMCID: PMC9737514 DOI: 10.1016/j.ctim.2022.102907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Coronavirus disease-2019 (COVID-19) pandemic continues, and the death toll continues to surge. Ozone therapy has long been used in the treatment of a variety of infectious diseases, probably through its antioxidant properties and the supply of oxygen to hypoxic tissues. This systematic review and meta-analysis aimed to determine the efficacy of ozone on mortality in patients with COVID-19. METHODS A systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Prospective controlled trials on treatment of COVID-19 with ozone, compared with placebo or blank, were reviewed. Studies were pooled to risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (CIs). RESULTS Eight trials (enrolling 371 participants) met the inclusion criteria. Ozone therapy showed significant effects on mortality (RR 0.38, 95% CI 0.17-0.85; P = 0.02), length of hospital stay (WMD -1.63 days, 95% CI -3.05 to -0.22 days; P = 0.02), and polymerase chain reaction (PCR) positivity (RR 0.07, 95% CI 0.01-0.34; P = 0.001). CONCLUSIONS Ozone therapy significantly reduced mortality, PCR positivity, and length of stay in hospitalized patients with COVID-19. Ozone therapy should be considered for COVID-19 patients.
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Affiliation(s)
- Wenli Shang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi 710068, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
| | - Guizuo Wang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi 710068, China
| | - Dong Han
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi 710068, China,Correspondence to: Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, No. 256, West Youyi Road, Xi’an, Shaanxi 710068, China
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5
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Epelle EI, Macfarlane A, Cusack M, Burns A, Okolie JA, Mackay W, Rateb M, Yaseen M. Ozone application in different industries: A review of recent developments. CHEMICAL ENGINEERING JOURNAL (LAUSANNE, SWITZERLAND : 1996) 2023; 454:140188. [PMID: 36373160 PMCID: PMC9637394 DOI: 10.1016/j.cej.2022.140188] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 06/01/2023]
Abstract
Ozone - a powerful antimicrobial agent, has been extensively applied for decontamination purposes in several industries (including food, water treatment, pharmaceuticals, textiles, healthcare, and the medical sectors). The advent of the COVID-19 pandemic has led to recent developments in the deployment of different ozone-based technologies for the decontamination of surfaces, materials and indoor environments. The pandemic has also highlighted the therapeutic potential of ozone for the treatment of COVID-19 patients, with astonishing results observed. The key objective of this review is to summarize recent advances in the utilisation of ozone for decontamination applications in the above-listed industries while emphasising the impact of key parameters affecting microbial reduction efficiency and ozone stability for prolonged action. We realise that aqueous ozonation has received higher research attention, compared to the gaseous application of ozone. This can be attributed to the fact that water treatment represents one of its earliest applications. Furthermore, the application of gaseous ozone for personal protective equipment (PPE) and medical device disinfection has not received a significant number of contributions compared to other applications. This presents a challenge for which the correct application of ozonation can mitigate. In this review, a critical discussion of these challenges is presented, as well as key knowledge gaps and open research problems/opportunities.
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Affiliation(s)
- Emmanuel I Epelle
- School of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
- ACS Clothing, 6 Dovecote Road Central Point Logistics Park ML1 4GP, United Kingdom
| | - Andrew Macfarlane
- ACS Clothing, 6 Dovecote Road Central Point Logistics Park ML1 4GP, United Kingdom
| | - Michael Cusack
- ACS Clothing, 6 Dovecote Road Central Point Logistics Park ML1 4GP, United Kingdom
| | - Anthony Burns
- ACS Clothing, 6 Dovecote Road Central Point Logistics Park ML1 4GP, United Kingdom
| | - Jude A Okolie
- Gallogly College of Engineering, University of Oklahoma, USA
| | - William Mackay
- School of Health & Life Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
| | - Mostafa Rateb
- School of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
| | - Mohammed Yaseen
- School of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
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6
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Jafari-Oori M, Vahedian-azimi A, Ghorbanzadeh K, Sepahvand E, Dehi M, Ebadi A, Izadi M. Efficacy of ozone adjuvant therapy in COVID-19 patients: A meta-analysis study. Front Med (Lausanne) 2022; 9:1037749. [PMID: 36438064 PMCID: PMC9685165 DOI: 10.3389/fmed.2022.1037749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 10/14/2023] Open
Abstract
Introduction Using ozone therapy to manage COVID-19 patients has been accompanied by conflicting results in prior studies. Therefore, we aimed to widely assess the effects of ozone as adjuvant therapy in COVID-19 patients. Methods PubMed, Scopus, Web of Science, Cochrane, ProQuest, Springer, and Sage journals were searched systematically until April 2022. Mortality rate, ICU admission, hospital-length stay, negative PCR, pulmonary, renal, and hepatic functions, as well as inflammatory and blood systems were pooled to compare the efficacy of ozone as adjacent therapy (OZ) and standard treatment (ST). Analyses were run with the random/fixed models, sub-group analysis, funnel plot, and sensitivity analysis using comprehensive meta-analysis (CMA) software version 2.0. Results The results of four randomized clinical trials (RCTs) and four case-control studies with a total of 371 COVID-19 positive patients were analyzed. The OZ group patients had a shorter length of hospital stay (P > 0.05), lower ICU admissions (P > 0.05), and lower mortality rates (P < 0.05) than the ST group cases. After treatment, 41% more COVID-19 patients had negative PCR tests than the ST group (P < 0.05). Serum creatinine and urea levels were not modified in either group (P > 0.05). Moreover, except for albumin serum levels, which decreased significantly in the OZ group, serum bilirubin, ALT, and AST were not modified in either group (P > 0.05). Both arms did not show a decrease in C-reactive protein blood levels (P > 0.05), but the OZ group showed a significant modification in LDH serum levels (P < 0.05). Unlike the d-dimer and WBC serum levels (P > 0.05), platelet levels were increased in the OZ group (P < 0.05). No negative side effects were demonstrated in either group. Conclusion Ozone therapy was effective significantly on PCR test and LDH serum levels, as well as mortality based on overall estimation. Concerning the length of hospital stay and ICU admissions, although the results were insignificant, their effect sizes were notable clinically. More RCT studies are needed to show the efficacy of ozone therapy on other studied variables.
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Affiliation(s)
- Mehdi Jafari-Oori
- Atherosclerosis Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kobra Ghorbanzadeh
- Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Elham Sepahvand
- Social Determinants of Health Research Center, Poledokhtar School of Nursing, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Manijeh Dehi
- Department of Nursing, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Abbas Ebadi
- Faculty of Nursing, Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mortaza Izadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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7
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The Mito-Hormetic Mechanisms of Ozone in the Clearance of SARS-CoV2 and in the COVID-19 Therapy. Biomedicines 2022; 10:biomedicines10092258. [PMID: 36140358 PMCID: PMC9496465 DOI: 10.3390/biomedicines10092258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
An increasing body of evidence in the literature is reporting the feasibility of using medical ozone as a possible alternative and adjuvant treatment for COVID-19 patients, significantly reducing hospitalization time, pro-inflammatory indicators, and coagulation markers and improving blood oxygenation parameters. In addition to the well-described ability of medical ozone in counteracting oxidative stress through the upregulation of the main anti-oxidant and scavenging enzymes, oxygen–ozone (O2–O3) therapy has also proved effective in reducing chronic inflammation and the occurrence of immune thrombosis, two key players involved in COVID-19 exacerbation and severity. As chronic inflammation and oxidative stress are also reported to be among the main drivers of the long sequelae of SARS-CoV2 infection, a rising number of studies is investigating the potential of O2–O3 therapy to reduce and/or prevent the wide range of post-COVID (or PASC)-related disorders. This narrative review aims to describe the molecular mechanisms through which medical ozone acts, to summarize the clinical evidence on the use of O2–O3 therapy as an alternative and adjuvant COVID-19 treatment, and to discuss the emerging potential of this approach in the context of PASC symptoms, thus offering new insights into effective and safe nonantiviral therapies for the fighting of this devastating pandemic.
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8
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Setyo Budi D, Fahmi Rofananda I, Reza Pratama N, Sutanto H, Sukma Hariftyani A, Ratna Desita S, Zinedinita Rahmasari A, Pudy Asmarawati T, Agung Waskito L, Dyah Kencono Wungu C. Ozone as an adjuvant therapy for COVID-19: A systematic review and meta-analysis. Int Immunopharmacol 2022; 110:109014. [PMID: 35803132 PMCID: PMC9250927 DOI: 10.1016/j.intimp.2022.109014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Ozone adjuvant in COVID-19 management showed conflicting results in prior studies. Here, we aimed to comprehensively evaluate benefits and side effects of ozone as adjuvant therapy in COVID-19 patients. METHODS Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and ProQuest for articles investigating ozone as adjuvant therapy in COVID-19. Clinical and laboratory outcomes, mortality, length of hospital stay, intensive care unit (ICU) admission, and adverse events were assessed. RESULTS Thirteen studies were included in this review. Case-control studies, but not randomized controlled trials (RCTs), showed a decrease in mortality following ozone therapy (OR = 0.24 (95% CI [0.07-0.76]), p = 0.02, I2 = 0%, fixed-effect). However, ozone therapy did not improve the length of hospital stay (SMD = -0.99 (95 %CI -2.44 to 0.45), p = 0.18, I2 = 84%, random-effects) and ICU admission (RR = 0.57 (95 %CI [0.05-6.71]), I2 = 73%, p = 0.65, random-effects). Consecutive case control studies suggested that ozone therapy significantly improved levels of D-dimer (p = 0.0060), lactate dehydrogenase (LDH; p = 0.0209), C-reactive protein (CRP; p = 0.0040) and interleukin (IL)-6 (p = 0.0048) as compared to standard therapy alone. CONCLUSIONS The beneficial effect of ozone in COVID-19 management seems to be limited to the improvements of laboratory parameters among severe patients, including the reduction of IL-6, LDH, CRP, and D-dimer levels. Meanwhile, other study endpoints, such as mortality, length of stay and ICU admission, were not improved following ozone therapy, although it may partly be due to a shorter duration of viral clearance. Furthermore, no serious adverse event was reported following ozone therapy, suggesting its high safety profile. (PROSPERO ID: CRD42021278018).
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Affiliation(s)
| | | | | | - Henry Sutanto
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands,Department of Physiology and Pharmacology, State University of New York (SUNY) Downstate Health Sciences University, NY, USA
| | | | | | | | - Tri Pudy Asmarawati
- Department of Internal medicine, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Langgeng Agung Waskito
- Department of Internal medicine, Faculty of Medicine, Universitas Airlangga, Indonesia,Institute of Tropical Disease, Universitas Airlangga, Indonesia,Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Institute of Tropical Disease, Universitas Airlangga, Indonesia; Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Indonesia.
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9
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Cenci A, Macchia I, La Sorsa V, Sbarigia C, Di Donna V, Pietraforte D. Mechanisms of Action of Ozone Therapy in Emerging Viral Diseases: Immunomodulatory Effects and Therapeutic Advantages With Reference to SARS-CoV-2. Front Microbiol 2022; 13:871645. [PMID: 35531273 PMCID: PMC9069003 DOI: 10.3389/fmicb.2022.871645] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022] Open
Abstract
Medical oxygen-ozone (O2-O3) is a successful therapeutic approach accounting on the assessed beneficial action of ozone in the range 30–45 μg/ml (expanded range 10–80 μg/ml according to different protocols), as in this dosage range ozone is able to trigger a cellular hormetic response via the modulating activity of reactive oxygen species (ROS), as signaling molecules. The ozone-dependent ROS-mediated fatty acid oxidation leads to the formation of lipid ozonization products (LOPs), which act as signal transducers by triggering ROS signaling and therefore mitohormetic processes. These processes ultimately activate survival mechanisms at a cellular level, such as the Nrf2/Keap1/ARE system activation, the AMPK/FOXO/mTOR/Sir1 pathway and the Nrf2/NF-kB cross talk. Furthermore, indirectly, via these pathways, LOPs trigger the HIF-1α pathway, the HO-1 signaling and the NO/iNOS biochemical machinery. Ozone-driven shift of cytokine activation pathways, from pro-inflammatory to anti-inflammatory immediately afterwards, also exert direct immunoregulatory effects on regulatory T lymphocytes as well as on the intestinal microbiota, which in turn can affect immune response thus influencing the progression of the disease. In this review, we will describe the biological and biochemical mechanisms of action of ozone therapy with the aim of evaluating both positive and critical aspects of ozone use as a therapeutic adjuvant in the light of emerging viral infections, such as SARS-CoV-2 and microbiome-associated disorders related to SARS-CoV-2.
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Affiliation(s)
- Alessandra Cenci
- Core Facilities, Italian National Institute of Health, Rome, Italy
- *Correspondence: Alessandra Cenci,
| | - Iole Macchia
- Department of Oncology and Molecular Medicine, Italian National Institute of Health, Rome, Italy
| | - Valentina La Sorsa
- Research Coordination and Support Service, Italian National Institute of Health, Rome, Italy
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10
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Yousefi B, Banihashemian SZ, Feyzabadi ZK, Hasanpour S, Kokhaei P, Abdolshahi A, Emadi A, Eslami M. Potential therapeutic effect of oxygen-ozone in controlling of COVID-19 disease. Med Gas Res 2022; 12:33-40. [PMID: 34677149 PMCID: PMC8562402 DOI: 10.4103/2045-9912.325989] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/29/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022] Open
Abstract
Atmospheric ozone is produced when nitrogen oxides react with volatile organic compounds. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome contains a unique N-terminal fragment in the Spike protein, which allows it to bind to air pollutants in the environment. 'Our approach in this review is to study ozone and its effect on the SARS-CoV-2 virus and patients with coronavirus disease 2019 (COVID-19). Article data were collected from PubMed, Scopus, and Google Scholar databases. Ozone therapy has antiviral properties, improves blood flow, facilitates the transfer of oxygen in hypoxemic tissues, and reduces blood coagulation phenomena in COVID-19 patients. Ozone has immunomodulatory effects by modulating cytokines (reduction of interleukin-1, interleukin-6, tumor necrosis factor-α, and interleukin-10), induction of interferon-γ, anti-inflammatory properties by modulating NOD-, LRR- and pyrin domain-containing protein 3, inhibition of cytokine storm (blocking nuclear factor-κB and stimulating nuclear factor erythroid 2-related factor 2 pathway), stimulates cellular/humoral immunity/phagocytic function and blocks angiotensin-converting enzyme 2. In direct oxygen-ozone injection, oxygen reacts with several biological molecules such as thiol groups in albumin to form ozonoids. Intravenous injection of ozonated saline significantly increases the length of time a person can remain hypoxic. The rectal ozone protocol is rectal ozone insufflation, resulting in clinical improvement in oxygen saturation and biochemical improvement (fibrinogen, D-dimer, urea, ferritin, LDH, interleukin-6, and C-reactive protein). In general, many studies have shown the positive effect of ozone therapy as a complementary therapy in the recovery of COVID-19 patients. All the findings indicate that systemic ozone therapy is nontoxic and has no side effects in these patients.
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Affiliation(s)
- Bahman Yousefi
- Department of Immunology, Semnan University of Medical Sciences, Semnan, Iran
| | | | | | - Sahar Hasanpour
- Department of Microbiology and Mycology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Parviz Kokhaei
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Oncology-Pathology, BioClinicum, Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Anna Abdolshahi
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Emadi
- Deputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Eslami
- Department of Bacteriology and Virology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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11
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Santinelli L, Laghi L, Innocenti GP, Pinacchio C, Vassalini P, Celani L, Lazzaro A, Borrazzo C, Marazzato M, Tarsitani L, Koukopoulos AE, Mastroianni CM, d'Ettorre G, Ceccarelli G. Oral Bacteriotherapy Reduces the Occurrence of Chronic Fatigue in COVID-19 Patients. Front Nutr 2022; 8:756177. [PMID: 35096923 PMCID: PMC8790565 DOI: 10.3389/fnut.2021.756177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Long COVID refers to patients with symptoms as fatigue, “brain fog,” pain, suggesting the chronic involvement of the central nervous system (CNS) in COVID-19. The supplementation with probiotic (OB) would have a positive effect on metabolic homeostasis, negatively impacting the occurrence of symptoms related to the CNS after hospital discharge. On a total of 58 patients hospitalized for COVID-19, 24 (41.4%) received OB during hospitalization (OB+) while 34 (58.6%) taken only the standard treatment (OB–). Serum metabolomic profiling of patients has been performed at both hospital acceptance (T0) and discharge (T1). Six months after discharge, fatigue perceived by participants was assessed by administrating the Fatigue Assessment Scale. 70.7% of participants reported fatigue while 29.3% were negative for such condition. The OB+ group showed a significantly lower proportion of subjects reporting fatigue than the OB– one (p < 0.01). Furthermore, OB+ subjects were characterized by significantly increased concentrations of serum Arginine, Asparagine, Lactate opposite to lower levels of 3-Hydroxyisobutirate than those not treated with probiotics. Our results strongly suggest that in COVID-19, the administration of probiotics during hospitalization may prevent the development of chronic fatigue by impacting key metabolites involved in the utilization of glucose as well as in energy pathways.
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Affiliation(s)
- Letizia Santinelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luca Laghi
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy.,Interdepartmental Centre for Agri-Food Industrial Research, University of Bologna, Bologna, Italy
| | | | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Vassalini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Marazzato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alexia E Koukopoulos
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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12
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The Relationship between Ozone and Human Blood in the Course of a Well-Controlled, Mild, and Transitory Oxidative Eustress. Antioxidants (Basel) 2021; 10:antiox10121946. [PMID: 34943049 PMCID: PMC8750071 DOI: 10.3390/antiox10121946] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022] Open
Abstract
In the last twenty years there has been a proliferation of articles on the therapeutic use of ozone. As it is well-known, the term ozone therapy is very broad. It ranges from either systemic or loco-regional administration of unstable gaseous oxygen/ozone mixtures to the topical application of stable ozonated derivatives. Anyway, in relation to the absence of specific receptors and the extreme reactivity with the biological liquids with which it comes into contact, gaseous ozone cannot be classified as either a drug or a pro-drug. When the gaseous ozone impacts a biological matrix, both reactive oxygen species (ROS) and lipid oxidation products (LOPs) are formed. They represent the effector molecules responsible for modulating the therapeutic activity in the body. Apart from the merits of the action mechanisms resulting from the use of ozone, this article seeks to validate the practice of ozone therapy as an adjuvant treatment in full compliance with the physiology of the whole organism.
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13
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Sozio E, De Monte A, Sermann G, Bassi F, Sacchet D, Sbrana F, Ripoli A, Curcio F, Fabris M, Marengo S, Italiani D, Luciana Boccalatte-Rosa D, Tascini C. CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial. Int Immunopharmacol 2021; 98:107874. [PMID: 34186281 PMCID: PMC8196321 DOI: 10.1016/j.intimp.2021.107874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia. METHODS The trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT). RESULTS A total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients). The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p = 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease. No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/FiO2, reduction in LDH and requirement of oxygen therapy ≤ 5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0-1] in the SoC arm vs. 2 [1-3] the O3-AHT arm; p = 0.018). No adverse events related O3-AHT treatment was observed. CONCLUSION In mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in a composite clinical endpoint. Larger Randomized prospective studies alone or in combination with steroids are needed to confirm our results.
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Affiliation(s)
- Emanuela Sozio
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Amato De Monte
- SOC Anestesia e Rianimazione 1, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Giovanni Sermann
- SOC Anestesia e Rianimazione 1, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Flavio Bassi
- SOC Anestesia e Rianimazione 2, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Davide Sacchet
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monastrio, Via Moruzzi1, Pisa, Italy.
| | - Andrea Ripoli
- Deep Health Unit, Fondazione Toscana "Gabriele Monasterio", Pisa, Italy.
| | - Francesco Curcio
- Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine (ASUID), Udine, Italy.
| | - Martina Fabris
- Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine (ASUID), Udine, Italy.
| | - Stefania Marengo
- SC di Medicina Interna e Unità di Terapia Semi Intensiva Internistica, Ordine Mauriziano di Torino, Torino, Italy.
| | | | | | - Carlo Tascini
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
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14
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Rizzo S, Savastano MC, Bortolotti D, Savastano A, Gambini G, Caccuri F, Gentili V, Rizzo R. COVID-19 Ocular Prophylaxis: The Potential Role of Ozonated-Oils in Liposome Eyedrop Gel. Transl Vis Sci Technol 2021; 10:7. [PMID: 34351367 PMCID: PMC8354035 DOI: 10.1167/tvst.10.9.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose To assess whether ozonated-oil in liposome eyedrop gel (OED) could be used to prevent the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection in an in vitro infection model. Methods First, we tested the efficacy of OED on in vitro cell regeneration and dry eye resolution in human corneal epithelial cells (hCE-2). Second, we assessed the in vitro anti-SARS-CoV-2 infection efficacy of OED using Vero E6 cells. Tissues were examined to assess different parameters: morphology, histology, and mRNA expression at 24 hours after treatment. Results OED could restore 50% of the scratch in the monolayer of hCE-2 cells in vitro compared with the 25% obtained with phosphate-buffered saline solution (PBS). At 24 hours after treatment with OED, the number of microvilli and the mucin network were restored, as observed using scanning electron microscopy. In Vero E6 cells infected with a primary SARS-CoV-2 strain and treated with OED two times/day, viral replication was found to be inhibited, with a 70-fold reduction observed at 72 hours after infection compared with that under the untreated and PBS-treated conditions. Conclusions SARS-CoV-2 transmission through the ocular surface should not be ignored. Although the prevalence of coronavirus disease 2019 conjunctivitis infection is low, the need for a barrier to prevent possible viral infection is warranted. OED treatment may prevent the risk of SARS-CoV-2 infection after 72 hours of twice-daily applications. Translational Relevance Dry eye condition might be a risk factor for SARS-CoV-2 infection and OED treatment may have a preventive role.
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Affiliation(s)
- Stanislao Rizzo
- Unit of Ophthalmology, "Fondazione Policlinico A Gemelli IRCCS," Rome, Italy.,"Università Cattolica Sacro Cuore", Rome, Italy.,Consiglio Nazionale delle Ricerche (CNR), Istituto di Neuroscienze, Pisa, Italy
| | - Maria Cristina Savastano
- Unit of Ophthalmology, "Fondazione Policlinico A Gemelli IRCCS," Rome, Italy.,"Università Cattolica Sacro Cuore", Rome, Italy
| | - Daria Bortolotti
- University of Ferrara, Department of Chemical, Pharmaceutical and Agricultural Sciences, Ferrara, Italy
| | - Alfonso Savastano
- Unit of Ophthalmology, "Fondazione Policlinico A Gemelli IRCCS," Rome, Italy.,"Università Cattolica Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Unit of Ophthalmology, "Fondazione Policlinico A Gemelli IRCCS," Rome, Italy.,"Università Cattolica Sacro Cuore", Rome, Italy
| | - Francesca Caccuri
- Department of Microbiology and Virology, "Spedali Civili," Brescia, Italy
| | - Valentina Gentili
- University of Ferrara, Department of Chemical, Pharmaceutical and Agricultural Sciences, Ferrara, Italy
| | - Roberta Rizzo
- University of Ferrara, Department of Chemical, Pharmaceutical and Agricultural Sciences, Ferrara, Italy
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15
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Chirumbolo S, Valdenassi L, Simonetti V, Bertossi D, Ricevuti G, Franzini M, Pandolfi S. Insights on the mechanisms of action of ozone in the medical therapy against COVID-19. Int Immunopharmacol 2021; 96:107777. [PMID: 34020394 PMCID: PMC8112288 DOI: 10.1016/j.intimp.2021.107777] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
An increasing amount of reports in the literature is showing that medical ozone (O3) is used, with encouraging results, in treating COVID-19 patients, optimizing pain and symptoms relief, respiratory parameters, inflammatory and coagulation markers and the overall health status, so reducing significantly how much time patients underwent hospitalization and intensive care. To date, aside from mechanisms taking into account the ability of O3 to activate a rapid oxidative stress response, by up-regulating antioxidant and scavenging enzymes, no sound hypothesis was addressed to attempt a synopsis of how O3 should act on COVID-19. The knowledge on how O3 works on inflammation and thrombosis mechanisms is of the utmost importance to make physicians endowed with new guns against SARS-CoV2 pandemic. This review tries to address this issue, so to expand the debate in the scientific community.
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Affiliation(s)
- Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Luigi Valdenassi
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Italy; SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy
| | - Vincenzo Simonetti
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Italy; SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy
| | - Dario Bertossi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology Unit of Maxillo-Facial Surgery University of Verona, Verona, Italy
| | | | - Marianno Franzini
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Italy; SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy
| | - Sergio Pandolfi
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Italy; SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy; Villa Mafalda Clinics via Monte delle Gioie, Rome, Italy
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16
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Fernández-Cuadros ME, Albaladejo-Florín MJ, Álava-Rabasa S, Gallego-Galiana J, Pérez-Cruz GF, Usandizaga-Elio I, Pacios E, Torres-García DE, Peña-Lora D, Casique-Bocanegra L, López-Muñoz MJ, Rodríguez-de-Cía J, Pérez-Moro OS. Compassionate Use of Rectal Ozone (O 3) in Severe COVID-19 Pneumonia: a Case-Control Study. ACTA ACUST UNITED AC 2021; 3:1185-1199. [PMID: 33778374 PMCID: PMC7984736 DOI: 10.1007/s42399-021-00849-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
Objectives To evaluate effect of rectal ozone in severe COVID-19 pneumonia and to compare it to standard of care (SOC). Material and Methods In a case-control study, 14 patients with severe bilateral COVID-19 pneumonia (positive RT-PCR), treated with SOC and rectal ozone, were evaluated before-and-after treatment and compared with SOC (14 patients) in a 10-day follow-up period. Ozone protocol consisted of 8 sessions (1 session/day) of intra-rectal ozone (150 mL volume, 35 μg/mL concentration [5.25mg total dose]). The SOC protocol included O2 supply, antivirals (Remdesivir), corticosteroids (Dexamethasone/Metilprednisolone), monoclonal antibodies (Anakinra/Tocilizumab), antibiotics (Azytromicine), and anticoagulants (Enoxaparine). Primary outcome variables were the following: (a) clinical (O2 saturation and O2 supply); (b) biochemical (lymphocyte count, fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP); (c) radiological Taylor’s scale. Secondary outcome variables were the following: (a) hospitalization length of stay, (b) mortality rate. Results At baseline, ozone/SOC groups were not different on age, comorbidities, O2 saturation, and O2 supply. Patients in the ozone group improved O2 saturation and decrease O2 supply. SOC maintained O2 saturation and required more O2 supply. Lymphocyte count improved only in the ozone group and with statistical difference (p<0.05). Biomarkers of inflammation (fibrinogen, D-dimer, urea, LDH, CRP, and IL-6) decreased in both groups, but only significantly in favor of the ozone group (p<0.05). Ferritin showed a significant decrease in the ozone group but an increase on the SOC group. Radiological pneumonitis decreased on both groups but the decrease was only significant in the ozone group (p<0.0001). Mortality and length of stay, although not significant, were inferior in the ozone group. Conclusion Compassionate use of rectal ozone improved O2 saturation, reduced O2 supply, decreased inflammation biomarkers, and improved Taylor’s radiological scale significantly when compared to the SOC group. Mortality and length of stay were inferior in the ozone group, but this difference was not significant.
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Affiliation(s)
- Marcos Edgar Fernández-Cuadros
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Santa Cristina, Calle del Maestro Vives 2 y 3, 28009 Madrid, Spain
| | - María Jesús Albaladejo-Florín
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Santa Cristina, Calle del Maestro Vives 2 y 3, 28009 Madrid, Spain
| | - Sandra Álava-Rabasa
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Santa Cristina, Calle del Maestro Vives 2 y 3, 28009 Madrid, Spain
| | - Juan Gallego-Galiana
- Servicio de Medicina Interna, Hospital Universitario Santa Cristina, Madrid, Spain
| | | | | | - Enrique Pacios
- Servicio de Medicina Interna, Hospital Universitario Santa Cristina, Madrid, Spain
| | | | - Daiana Peña-Lora
- Unidad de Geriatría, Hospital Universitario Santa Cristina, Madrid, Spain
| | | | | | | | - Olga Susana Pérez-Moro
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Santa Cristina, Calle del Maestro Vives 2 y 3, 28009 Madrid, Spain
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17
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Chirumbolo S, Franzini M, Simonetti V, Valdenassi L, Ricevuti G, Bertossi D, Pandolfi S. Oxygen-ozone autohemotherapy against COVID-19 needs to fit highly experienced, customized, and standardized protocols to succeed. J Med Virol 2021; 93:2580-2582. [PMID: 33503267 PMCID: PMC8013854 DOI: 10.1002/jmv.26806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marianno Franzini
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy.,SIOOT International, Communian Clinic, Gorle Bergamo, Italy
| | | | - Luigi Valdenassi
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy.,SIOOT International, Communian Clinic, Gorle Bergamo, Italy
| | - Giovanni Ricevuti
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy.,SIOOT International, Communian Clinic, Gorle Bergamo, Italy
| | - Dario Bertossi
- Department of Surgery, Dentistry, Pediatrics and Gynaecology Unit of Maxillo-Facial Surgery, University of Verona, Verona, Italy
| | - Sergio Pandolfi
- SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy.,SIOOT International, Communian Clinic, Gorle Bergamo, Italy
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18
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Safety and efficacy of ozone therapy in mild to moderate COVID-19 patients: A phase 1/11 randomized control trial (SEOT study). Int Immunopharmacol 2020; 91:107301. [PMID: 33421928 PMCID: PMC7758022 DOI: 10.1016/j.intimp.2020.107301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/18/2022]
Abstract
Introduction The Corona virus disease 19 (COVID-19) has accounted for multiple deaths and economic woes.While the entire medical fraternity and scientists are putting their best feet forward to find a solution to contain this deadly pandemic, there is a growing interest in integrating other known alternative therapies in to standard care. This study is aimed at evaluating the safety and efficacy of ozone therapy (OT), as an adjuvant to the standard of care (SOC). Methods In the current randomized control trial, 60 patients with mild to moderate score NEWS score were included in two parallel groups (n = 30/group). The interventional group (OZ) received ozonized rectal insufflation and minor auto haemotherapy, daily along with SOC, while the control group (ST) received SOC alone. The main outcome measures included changes in clinical features, oxygenation index (SpO2), NEWS score, Reverse transcription polymerase chain reaction(RT-PCR), inflammatory markers, requirement of advanced care, and metabolic profiles. Results The OZ group has shown clinically significant improvement in the mean values of all the parameters tested compared to ST Group. However, statistical significance were only observed in RT-PCR negative reaction (P = 0.01), changes in clinical symptoms (P < 0.05) and requirement for Intensive care (P < 0.05). No adverse events were reported in OZ group, as against 2 deaths reported in ST group. Conclusion OT when integrated with SOC can improve the clinical status and rapidly reduce the viral load compared to SOC alone, which facilitate early recovery and check the need for advanced care and mortality as demonstrated in this study.
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